Clinical Investigation Award

The Educational and Research Foundation for the American Academy of Facial Plastic and Reconstructive Surgery – Clinical Investigation Award Application

This form must be completed and submitted with your Curriculum Vitae and Letters of Support to the AAFPRS Foundation office before the deadline of July 1. You may e-mail this form and attachments to: ksloat@aafprs.org , FAX to the attention of Karen Sloat at 703-299-8284, or mail to the AAFPRS, Attention: Karen Sloat, 310 S. Henry Street, Alexandria, VA 22314. Applicants will be informed at least four weeks prior to the appropriate AAFPRS meeting as to decisions made by the Research Center Committee.

Applicant Name:*

Address

Street AddressCityState / Province / RegionZIP / Postal Code

Telephone:*

Email Address*

Applicant statement as to goals and interests in the area of Research (1000 word limit)

Please provide preliminary budget information as to how funds will be utilized: